Future of icodextrin as an osmotic agent in peritoneal dialysis

Abstract

One of the most notable advances in peritoneal dialysis (PD) technology during the past two decades has been the development and introduction in clinical practice of a new generation of PD solutions designed to address specific clinical and biologic aspects of the therapy. These solutions have been developed to tackle the issues of enhanced ultrafiltration (alternative osmotic agents), nutritional support (amino acid containing solutions), and peritoneal membrane preservation (alternate buffer systems and physiologic pH)1,2,3. Icodextrin-based solutions have been the longest in clinical use since their development two decades ago4, and have accumulated large clinical experience regarding their efficacy and safety. This is reflected in their widespread acceptance and common use in countries where they are available. Icodextrin-based solutions differ from the conventional PD fluids not only in the nature of the osmotic agent, but also in the mechanism by which they lead to ultrafiltration. These solutions induce effective transcapillary ultrafiltration through colloid osmosis during dwells of more than 12 hours. Therefore, icodextrin-based solutions promote an equal or better and more long-lasting ultrafiltration profile than glucose solutions during the long dwell without the problems of hyperosmolality and high glucose content of the latter.